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Incident Reporting Form (Ir 01) : Fatality Lti I RWC Accident NEAR Miss

1) An incident report was filed for a near miss accident that occurred at the P. Plant utility boiler area. 2) The incident involved technician Muhammad Umar tripping on an uneven floor near Boiler No. 08, but he was not injured. 3) An immediate corrective action taken was to cordon off the area for repairs to be made to the uneven floor.

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392 views1 page

Incident Reporting Form (Ir 01) : Fatality Lti I RWC Accident NEAR Miss

1) An incident report was filed for a near miss accident that occurred at the P. Plant utility boiler area. 2) The incident involved technician Muhammad Umar tripping on an uneven floor near Boiler No. 08, but he was not injured. 3) An immediate corrective action taken was to cordon off the area for repairs to be made to the uneven floor.

Uploaded by

muhammadumar412296
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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PPL HSE / FM / IIR / 01

Rev 01
INCIDENT REPORTING FORM (IR 01)
Dept. / Field / Location: P. PLANT Area: UTILITY (Boiler No.08)

FATALITY LTI I RWC ACCIDENT NEAR Miss PROPERTY DAMAGE /


(e.g. MINOR FIRE / DAMAGE TO
INCIDENT / ENVIRONMENT
FIRST AID

Date of Incident: 08.02.2017 Time: 0745Hrs Reported by: Muhammad Umar

MPT
Name of affected: Muhammad Umar Employee No: 3345 Non MPT

Designation: Technician (Boiler) Department: P. Plant

Temporary / Permanent / Contract Labor Authorized to perform the task : YES NO

Was task supervised : YES NO

Occurrence of Not at Work During overtime Entering or leaving area / office

Incident Performing job alone Performing job in group


(Tick one)

Brief Description of Incident:


On 07 February 2017 at 0730 Hrs., during the round of boiler area my foot was struck due to uneven floor near the Boiler
no.08 F.D fan. But fortunate no injury occurred.
Witnesses: 1) Muhammad Younas 2) Mureed Hussain 3).

NATURE OF INJURY CLASSIFICATION OF INCIDENT POSSIBLE CAUSE (s) OF INCIDENT

Eyes Design or Layout Caught in /on/between


Equipment failure Striking against/struck by
Face / Head / Neck Motor vehicle accident
Construction Work Injured while handling, lifting or carrying
Arms Slips, Trips or falls
System of work method of
Overexertion/strain / position of person
operation
Hands Foreign Bodies/Objects
Operational conditions Trapped by something collapsing or overturning
Supervision Drowning or asphyxiation
Legs
Training Animal/Insect cases
Feet Guarding Contact with sharps
Maintenance Use of hand tools
Trunk Fire Thermal/chemical burns
Explosion Exposure to fire
Internal Gas Leak Exposure to an explosion
Oil / Chemical Spill Contact with electricity or an electrical discharge
Back Others Workplace violence
Failure to wear PPE
Deficiency of knowledge
Others
Personal Factors
Other kind of accidents

Treatment Provided:
Sent back to work Sent to Hospital Sent Home

Referred to Site Doctor Not Applicable


Immediate Corrective actions: This place cordon off till repairing.

Sectional Head: Name & Signature Location in charge: Name & Signature

Waheed Ahmad Majid Ali Siddiqui M(PP)


Date:08.02.2017 Date: 08.02.2017.
Comments:

All incidents must be reported to HSE at HO within 24 hrs on IR 01.


Investigation report to be generated within 5 days on IR 03 from the date of incident.
Near Miss incidents are not required to report on IR 03, except on directives of concerned Dept. Head / Field / Location Incharge / HSE
Dept. HO based on severity and nature of incident.

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